Another Implementation ChallengeTHE ELECTRONIC HALLWAYTM NETWORKIMPLEMENTING A NEW DRUG AND ALCOHOL TREATMENT MODELIN SACRAMENTO COUNTY "Drug Counseling by Social Workers Planned"The Sacramento Bee—Monday April 18, 1994Frustrated with the growing need for more drug and alcohol treatment,Sacramento County officials plan to train nurses, child welfare workers, andfront-line social workers to do substance abuse counseling. "Current treatmentservices meet less than a fourth of the demand, and about 800 people are onthe waiting lists for treatment,” said Robert Caulk, director of the county'sDepartment of Health and Human Services. "The system is saturated. The bestthing you can do about drug and alcohol abuse is treat it. We might as welltrain our labor force to deal with it. The new program [the Alcohol and DrugTreatment Initiative] calls for every social worker, mental health counselor,conservator, and public health nurse to provide drug and alcohol treatment.”It was June 1994. Toni Moore had just been hired by Robert Caulk, director of SacramentoCounty's 1200-member Department of Health and Human Services, as the project manager for thedepartment's Alcohol and Other Drug Treatment Initiative (AODTI). Moore's job was a big one:to take an idea in the developmental stages, build it into an actual program, and make it anintegral part of employees' daily work lives.Sacramento County's Department of Health and Human Services (DHHS) had been in operationfor two and a half years, following a 1992 countywide reorganization of the health and humanservices delivery system. As conceived by Robert Caulk, the AODTI fit nicely with DHHS' mission statement:- We deliver health, social, and mental health services to the Sacramento community.- We direct resources toward creative strategies and programs that prevent problems, improvewell being, and increase access to services for individuals and families.- To further our mission, we seek close working relationships among staff, with othergovernment offices, and within the community.This case study is made possible through the generous contributions of the Annie E. Casey Foundation as part of their support for this national curriculum development project. The case was prepared by Dail Bridges and Gwendolyn Campbell with supervision by Jon Brock, Associate Professor at the Daniel J. Evans School of Public Affairs, University of Washington. Gwendolyn Campbell also provided significant editorial input for this case.The Electronic Hallway is administered by the Cascade Center for Public Service, a branch of the University of Washington’s Institute for Public Policy and Management.Use of this case study is subject to the terms of the Subscriber Agreement (http://www.hallway.org/agree.htm). If the terms of this agreement are not acceptable to the user, user should terminate access and refrain from any storage, printout, distribution or other use of this material. This network material may not be altered or copied without written permission from the Electronic Hallway. The Electronic Hallway is administered by the University of Washington’s Daniel J. Evans School of Public Affairs. For more information, contact the Electronic Hallway at [email protected] or (206) 616-8777.Copyright 2000 Cascade Center for Public ServicePublic Service Curriculum ExchangeF96Implementing A New Drug And Alcohol Treatment Model In Sacramento CountyHaving the AODTI fit the department’s mission statement and gaining support for it from staffand managers were two different things—and Toni Moore knew this. Her first task was toconvince the department's staff and managers of the importance of the AODTI; only with theirsupport could she move the initiative forward. Little groundwork had been laid, and, for manystaff, the Sacramento Bee article was the first mention they had had of this far-reaching initiative.Some DHHS staff members were leery of the thought of more work and more training that mightblur the boundaries of their jobs. Others wondered about the liability issues involved in taking ontreatment work as a part of their work. And still others—especially DHHS' few trained alcoholand drug counselors—were concerned about bringing people with limited training and experienceinto treatment work. Finally, few DHHS employees were enthused about the possibility of anincreased workload. Workload issues were a constant struggle, and one with which thepredominately-unionized DHHS staff wrestled constantly.Similar feelings were rampant among the staff and administrators of the community-basedorganizations (CBOs) with which DHHS contracted to provide the lion’s share of the county'salcohol and other drug (AOD) treatment services. Alcohol and other drug treatment was theCBOs’ domain, so what would happen to their contracts if DHHS staff began providing the sameservices? Furthermore, every year without exception, the AOD programs had to cope withbudget cuts. How would the AODTI, a whole new program, affect their access to the funds thatthey already competed over? The CBOs, as a group, were uniformly concerned.Robert Caulk's VisionLong before Toni Moore had even heard of the AODTI, its development was unfolding in themind of Robert Caulk, the director of Sacramento County's Department of Health and HumanServices. Caulk had directed six or seven different agencies in his twenty-year career by the timehe came to Sacramento County in 1991, and he came with a reputation as a highly-drivenproblem-solver. Caulk exuded a restless energy in every area of his life—perhaps best displayedin his intensive training for competitive triathlons. From his experiences with other agencies,Caulk had come to believe that alcohol and other drug abuse was the underlying cause of nearlyevery problem the human services system saw, including child welfare, public health, mentalhealth, education and criminal justice, among others.Caulk's thoughts were precise as he began to put the pieces of his plan together. "Eighty percentof criminal justice cases are alcohol- and drug-related. Eighty percent of child abuse cases arealcohol- and drug-related. Emergency room and healthcare workers see huge numbers of alcohol-and drug-related cases. Alcohol and drug abuse drives everything, so we need to deal with